Effect of a Multi-Site Trial using Short Message Service (SMS) on Infant Feeding Practices and Weight Gain in Low-Income Minorities

BACKGROUND Although mobile health (mHealth) has been widely applied in health care services, few studies have reported the detailed process of the development and implementation of text messaging (short message service, SMS) interventions. OBJECTIVE Our study aims to demonstrate the process and lessons learned from a community-based text messaging (SMS) intervention for improving infant feeding in Shanghai, China. METHODS The intervention included planning and development, implementation, and process evaluation. A 3-phase process was adopted during planning and development: (1) a formative study with expectant and new mothers to explore the barriers of appropriate infant feeding practices; (2) a baseline questionnaire survey to understand potential intervention approaches; and (3) development of the text message bank. The text messaging intervention was delivered via a computer-based platform. A message bank was established before the start of the intervention containing information on the benefits of breastfeeding, preparing for breastfeeding, early initiation of breastfeeding, timely introduction of complementary foods, and establishing appropriate feeding practices, etc. An expert advisory committee oversaw the content and quality of the message bank. Process evaluation was conducted through field records and qualitative interviews with participating mothers. RESULTS We found that the text messaging intervention was feasible and well received by mothers because of its easy and flexible access. The weekly based message frequency was thought to be appropriate, and the contents were anticipatory and trustworthy. Some mothers had high expectations for timely response to inquiries. Occasionally, the text messages were not delivered due to unstable telecommunication transmission. Mothers suggested that the messages could be more personalized. CONCLUSIONS This study demonstrates the feasibility and value of text messaging intervention in filling gaps in delivering health care services and promoting healthy infant feeding practices in settings where personal contact is limited.

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Effect of a Short Message Service Intervention on Excessive Gestational Weight Gain in a Low-Income Population: A Randomized Controlled Trial

Nutrients ◽

10.3390/nu12051428 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1428

Author(s):

Hannah Holmes ◽

Cristina Palacios ◽

YanYan Wu ◽

Jinan Banna

Keyword(s):

Physical Activity ◽

Weight Gain ◽

Low Income ◽

Short Message Service ◽

Intervention Group ◽

Control Group ◽

Short Message ◽

Gestational Weight ◽

Excessive Gestational Weight Gain ◽

Message Service

Objectives: The objective of this trial was to investigate the effect of educational short message service (SMS), or text messages, on excessive gestational weight gain (GWG) in a low-income, predominantly overweight/obese population. Methods: Participants (n = 83) were mostly overweight/obese women recruited at Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics on the island of O’ahu, Hawai’i at 15–20 weeks gestational age. The intervention group received SMS on nutrition and physical activity during pregnancy designed to help them meet Institute of Medicine (IOM) guidelines for GWG and American College of Obstetricians and Gynecologists guidelines for exercise, respectively. The control group received SMS about general health topics during pregnancy, excluding nutrition and physical activity. Both groups received one text message per week for eighteen weeks. GWG was defined as the difference between the last self-reported weight taken before delivery and participants’ self-reported weight before pregnancy. Differences between study groups were examined using t-tests and Chi-square tests. Linear regression models were used to examine association of GWG with study group and other factors. Results: GWG was similar (p = 0.58) in the control group (14.1 ± 11.4 kg) and the intervention group (15.5 ± 11.6 kg). The percentage of participants exceeding IOM guidelines for GWG was similar (p = 0.51) in the control group (50.0%, n = 17) and the intervention group (60.5%, n = 23). Conclusions: GWG was not significantly different between intervention and control groups. Trials that begin earlier in pregnancy or before pregnancy with longer intervention durations and varying message frequency as well as personalized or interactive messages may be needed to produce significant improvements.

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Could mobile phone text messages be used for infant feeding education in Ethiopia? A formative qualitative study

Health Informatics Journal ◽

10.1177/1460458220911779 ◽

2020 ◽

Vol 26 (4) ◽

pp. 2614-2624

Author(s):

Kidane Tadesse Gebremariam ◽

Oksana Zelenko ◽

Znabu Hadush ◽

Afework Mulugeta ◽

Danielle Gallegos

Keyword(s):

Focus Group ◽

Mobile Phone ◽

Technology Acceptance ◽

Infant Feeding ◽

Low Income ◽

Short Message Service ◽

Text Messages ◽

Mobile Telephone ◽

Short Message ◽

Message Service

A majority of the world’s population now live in areas with a mobile telephone network. This expansion of the network enables people to use more mobile phone functionalities such as short message service, multimedia, and the Internet. Mobile phone–based health (mHealth) interventions have been considered to have benefits in low-income countries. The aim of this study was to explore the feasibility of a short message service for breastfeeding education in Ethiopia. Four focus groups—two with mothers and two with fathers—were conducted with a total of 41 participants. The focus group discussion recordings were transcribed in Tigrigna verbatim, and then translated to English. The data were analyzed using thematic analysis, underpinned by the technology acceptance model. The following four general themes emerged from the focus group discussions: (1) Mobile phones: integrated into everyday life; (2) SMS text messaging: anytime, anywhere, as long as there is a sound; (3) Marketing versus utility: a barrier to SMS; and (4) Scientific messages from credible experts are key to reading SMS-based messages. Parents in Ethiopia showed interest in receiving weekly infant feeding-related short messages. Short message service–based interventions could therefore be an option for improving knowledge and awareness of parents regarding infant feeding.

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Infant Feeding Practices and Perceived Optimal Breastfeeding Interventions among Low-Income Women Delivering at a Baby-Friendly Hospital

American Journal of Perinatology ◽

10.1055/s-0038-1676485 ◽

2018 ◽

Vol 36 (07) ◽

pp. 669-677 ◽

Cited By ~ 3

Author(s):

Adam K. Lewkowitz ◽

Nandini Raghuraman ◽

Julia D. López ◽

George A. Macones ◽

Alison G. Cahill

Keyword(s):

Infant Feeding ◽

Low Income ◽

Tertiary Care ◽

Feeding Practices ◽

Cross Sectional Study ◽

Perceived Usefulness ◽

Breastfeeding Initiation ◽

Infant Feeding Practices ◽

Cross Sectional ◽

Low Income Women

Objective To determine infant feeding practices of low-income women at a Baby-Friendly Hospital and to ascertain breastfeeding interventions they believe would increase exclusive breastfeeding. Study Design This cross-sectional study occurred at a tertiary care Baby-Friendly Hospital. Low-income women without breastfeeding contraindications were recruited at scheduled obstetrician/gynecologist appointments within 6 to 9 months of delivering a term, nonanomalous infant. Participants completed a survey. Outcomes included infant feeding patterns and perceived usefulness of proposed breastfeeding interventions. Results Of 149 participants, 129 (86.6%) initiated breastfeeding; by postpartum day 2 (PPD2), 47 (31.5%) exclusively breastfed, 51 (34.2%) breastfed with formula, and 51 (34.2%) exclusively formula fed. On a scale of 1 (“strongly agree”) to 5 (“strongly disagree”), women who supplemented with formula on PPD2 were significantly more likely than those who exclusively formula fed to agree education on neonatal behavior, 1 (interquartile range [IQR] 1, 2) versus 2 (IQR 1, 3); p = 0.026 and on-demand access to breastfeeding videos on latch or positioning, 1 (IQR 1, 2) versus 2 (IQR 1, 3), p = 0.043; 1 (IQR 1, 2) versus 2 (IQR 1, 3), p = 0.021, respectively, would have helped them exclusively breastfeed. Conclusion Though low-income women at a Baby-Friendly Hospital had high breastfeeding initiation rates, the majority used formula by PPD2. To increase breastfeeding rates among low-income women, future interventions should provide appropriate and effective breastfeeding interventions.

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